Processing Electronic Claims

Processing electronic claims consists of the following procedures.

Enter claims as you typically would.
Create an electronic claim batch file.
Print the pre-transmission report and remove any claims with errors (to be corrected in the patient’s chart and transmitted in the next batch).
Transmit the batch file.
Wait 24 hours and retrieve the transaction report.

To process electronic claims:

Enter the electronic claims as you would regular claims.

Click the Insurance Functions button from the main menu. The Insurance Functions menu is displayed. Select Claim Processing.

Select Functions > Insurance Functions > Claim Processing from the menu bar. The Insurance Claim Processing window is displayed.

Select Create Electronic Claims. The Actual Claims, One-Time Claims, and Cont Tx Claims options are selected, and the Print button changes to Create.

Click Create. The Print Insurance Claim window is displayed.

Click OK. The software generates the claims, and the Generate Electronic Claims window is displayed, showing the number of claims generated for this electronic batch.

To view and then transmit the batch of claims, click Yes. The Electronic Claims Maintenance window is displayed. See Electronic Claims Maintenance for information on this window.

Click Print Transmission Report. The Transmission Report Print Options window is displayed. Select print, print preview, or export and click OK.

If any of the claims is incomplete, the transmission report lists the information that is missing from the claim.

The software does not let you transmit the current batch when any claim is missing information. Use the Edit/View Claims function to remove any incomplete claims. See Editing/Viewing Electronic Claims for more information.

You can correct the claim in the electronic batch; however, the claim in the patient chart is still incomplete.

After you have corrected the errors or removed the claims with errors, perform one of these tasks.

Click OK. The File Transfer Status window is displayed, and the software begins transferring the files. When the transfer process is complete, the communications software closes.

Wait 24 hours after you transmit the batch file, and select Insurance Functions > Electronic Claims. The Electronic Claims Maintenance window is displayed. Click Retrieve Transaction Report. The Transaction Report combines several reports and contains the Transmission Log (list of claims transmitted), the Account Balance Summary, Provider Daily Statistics, Provider Daily Summary, and the Daily Acceptance Report by Provider.

If the transaction report is not ready when you connect to retrieve it, the software displays a message stating that the report is not ready. You cannot transmit claims again until you have retrieved the transaction report.